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Development of a clinical indicator-based severity scoring system for pediatric atopic dermatitis and evaluation of
Peng Ding1, Dongbo Zhang1, Xi Deng1
1Department of Dermatology, Affiliated Maternity and Child Health Care Hospital of Nantong University Nantong 226008, Jiangsu, China.
Insights
A new scoring system helps classify pediatric atopic dermatitis (AD) severity. Dupilumab treatment showed significant efficacy and safety in children with moderate-to-severe AD, improving clinical scores.
Area of Science:
- Dermatology
- Pediatrics
- Clinical Pharmacology
Background:
- Pediatric atopic dermatitis (AD) poses a significant clinical challenge.
- Accurate severity assessment is crucial for effective management.
- Existing scoring systems may lack routine clinical applicability.
Purpose of the Study:
- To develop and validate a practical scoring system for pediatric AD severity.
- To evaluate the efficacy and safety of dupilumab in children with moderate-to-severe AD.
Main Methods:
- Retrospective analysis of 236 pediatric AD patients, split into training and validation cohorts.
- Development of a scoring system based on clinical indicators and logistic regression.
- Evaluation of dupilumab efficacy using EASI, SCORAD, and PP-NRS scores at multiple time points.
- Adverse event monitoring during dupilumab treatment.
Main Results:
- A validated scoring system (0-9 points) incorporating onset age, xerosis, spiny lichen, vitamin D status, and eosinophil count was developed.
- The scoring system demonstrated good predictive accuracy (AUC 0.885 internal, 0.824 external).
- Dupilumab significantly improved AD severity scores, with high rates of EASI50, EASI75, and EASI90 achievement by week 16.
- Adverse events associated with dupilumab were mild and infrequent.
Conclusions:
- A simple, validated scoring system for pediatric AD severity is now available.
- Dupilumab is an effective and safe treatment option for children with moderate-to-severe AD.
Objective:
To develop and validate a pediatric atopic dermatitis (AD) severity scoring system based on routinely available clinical indicators and to evaluate the efficacy and safety of dupilumab in children with moderate-to-severe AD.
Methods:
Clinical data from 236 children with AD treated between January 2023 and January 2025 were retrospectively analyzed and randomly split into training and internal validation cohorts (7:3). An external validation cohort included 42 patients treated between February and June 2025. AD severity was classified using the SCORAD index. Factors associated with disease severity were identified by logistic regression, and a scoring system was developed and evaluated using receiver operating characteristic (ROC) and calibration curves. In addition, children with moderate-to-severe AD treated with dupilumab were assessed for changes in clinical scores at baseline and weeks 4, 12, and 16, with adverse events recorded.
Results:
The scoring system (0-9 points) included onset age ≤2 years, xerosis, spiny lichen, vitamin D insufficiency/deficiency, and eosinophil count ≥0.455×109/L. The areas under the ROC curve were 0.885 in the internal validation cohort and 0.824 in the external validation cohort, with good calibration. Dupilumab treatment significantly improved EASI, SCORAD, PP-NRS scores. At week 16, EASI50, EASI75, and EASI90 were achieved in 86.52%, 65.17%, and 33.71% of patients, respectively. Adverse events were mild and infrequent.
Conclusions:
A simple and practical severity scoring system for pediatric AD was developed and validated. Dupilumab demonstrated favorable efficacy and acceptable safety in children with moderate-to-severe AD.
